MEDICARE: DA JUNG ALBUS SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 23587	CA

General Provider Information

NPI Number	:	1720536147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DA JUNG ALBUS SLP

Provider Business Mailing Address
First Line	:	3570 LOUISIANA ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4023
Country	:	US
Telephone Number	:	989-506-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 LOUISIANA ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4023
Country	:	US
Telephone Number	:	989-506-6598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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Directions to “ DA JUNG ALBUS SLP” Practice Location

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